Essay: Introduction & implementation of a service improvement idea (Hearing Aid Picture or Sign)

INTRODUCTION
The aim of this assignment is to introduce a service improvement (SI) idea and change process necessary to implement the service improvement idea. The service improvement idea is a Hearing Aid Picture or Sign (HAP) attach by the patients’ bed to indicate the patients that need support with their hearing aids. This support might be; patients need to wear their hearing aids for hearing needs, changing the hearing aid batteries, ear check-up and updates or referring to the audiologist. This SI idea will be run first as a pilot study in a surgical ward of a hospital. The idea can then be introduced to other wards of the hospital that have patients with hearing impairment, especially the elderly patients who has the tendencies of hearing impairment (Hampson, 2012). The SI can also be introduced to the nursing homes, hospices and district homes where there are elderly patients with hearing impairment if permitted.
Goldberg et al. (2013) study emphasised that if the health professionals allow SI idea that is reliable and safe, it will improve their patients’ health and reduces the costs of delivering care for the National Health Service (NHS). Therefore, SI is important because it enables the health professionals to handle patients’ safety, improve the quality of patient care and provide patient centred care.
JUSTIFICATION FOR THE SI
Harkin and Kelleher (2011) describe hearing impairment or loss as damage to the inner, middle or external part of the ear due to constant exposure to loud sounds or develop with age especially in elderly people. In the United Kingdom (UK), there are more than 11 million people with some form of hearing loss, and more than 70% of this population are over 70 years-old (Action Hearing Loss, 2015). Many of these elderly people are in the hospital or residential homes as patient and unable to communicate their needs to the health professionals due to hearing impairment.
Ciorba et al. (2012) stated that the most common deficit in older patients is hearing loss, which affects their activities of daily living. Peate (2010) describes activities of daily living as routine activities that people tend to do every day without needing assistance from anyone. The basic activities of daily living such as personal hygiene, movement in bed, locomotion, dressing and feeding will be affected. This will result in deterioration in the elderly patients’ health due to lack of communication from hearing impairment.
As Grenness et al. (2014) and Action Hearing Loss (2015) affirmed that poor hearing care and lack of communication have negative effects on personal dignity, well-being and quality of life of an individual. The health care professionals should identify the cause of poor or lack of communication from patients for their wellbeing. McKee (2013) asserted that sufficient and effective hearing care promotes good communication and understanding of an individual with hearing impairment. As good communication is needed to promote good interaction between the patients and the healthcare professionals for patients’ quick recovery from illness.
Although Yorkston, Bourgeois and Baylor (2010) maintained that inadequate communication can be the main source of wellbeing problem and distress to patients with hearing impairment. The Social Care Institute for Excellence (SCIE) (2015) emphasised that lack of good communication can cause isolation which might lead to neglect or omission of care by the healthcare providers. The hearing impaired patients often go into isolation due to distress from lack of communication with the healthcare professionals.
Halder (2012) affirmed that effective communication, whether orally or non-orally is essential when giving care to patients with hearing impairment. Thus, adequate care that promotes effective communication between these patients who are vulnerable and healthcare providers should be used by all the healthcare professionals (Wynia and Osborn, 2010). This will facilitate the support the patients’ requirement for their basic care and wellbeing.
Aside from the lack of communication and reduced personal care, poor hearing care might lead to infections and pain causing further health deterioration (SCIE, 2015). Poor hearing care may also expose the health of a patient with hearing impairment to detrimental complications such as total deafness, huge earwax, tumour, Alzheimer’s disease, depression and Meniere’s disease (McKee, 2013, Grenness et al., 2014 and Hung et al., 2015). These happen when the patient’s with hearing impairment do not or can not explain what pain and distress they are going through to the healthcare professionals, therefore hindering the patients’ holistic care.
Regardless of the enormous disbursement by the NHS, the Action for hearing loss (2013) and Archbold et al. (2014) found that hearing loss for elderly patients in the hospital contributes to falls, misdiagnosed and mismanagement of other conditions and missing important schedule in-house (hospital) appointment. These and many more leads to patients being delayed at the hospital than the reasonable time specified for discharge, a situation that Francis (2013) described as appalling, unacceptable and undignified.
According to the latest research by the Department of Health (DH) (2016), found that hearing loss increases the risk of patient’s falls in the hospital. This happens as the elderly patients with hearing impairment could not hear or understand the health professionals during their care. Furthermore, the study established that a mild hearing loss made patients nearly three times as likely to have reported a fall in the previous years.
The Royal College of Physicians (2015) also reported that reduced mobility of the elderly patient with hearing impairment can also lead to continuous falls and pressure ulcers, leading to a longer stay in the hospital. These increase the cost of caring for falling patients in the hospital for the NHS. As Clwyd MP and Hart (2013) pointed out some of the consequences of not providing sufficient hearing care to patients in the hospital especially to the elderly patients. These include increased cost of delivering care, longer hospital stay, complaints, lawsuits and even sometimes death. These consequences are the ones NHS are trying to improve or eradicate.
Currently, the practice in the surgical ward of the chosen hospital is that during admission, all patients are assessed for disabilities and it is written down in the patient’s assessment folder. Some of these physical disabilities except for the hearing impaired are represented by an item which is easily noted. The healthcare professionals sometimes omit the hearing impaired as a major disability which might occur in elderly patients (Goldberg et al., 2013), and focuses on the disabilities such as blindness, loss of arms or legs and dementia.
Furthermore, Ciobra et al. (2012) found that most elderly patients with hearing impairment either suffered in silence or are given inadequate care because they do not want to bother anyone for their care including personal hygiene. Consequently, the health of patients with hearing impairment deteriorates in the absence of daily hygiene or medical care.
CHANGE MANAGEMENT AND MODEL
According to Sullivan and Gayle (2013), change in health care setting could be complicated, continuously occurring and rapidly, planned or unplanned, welcome or unwelcome situation. Kerzner (2013) argued that the company’s change plans are unsuccessful not because of project plans or incorrect plans or ideas but might be the behaviour of the workers. Gage (2013) asserted that changes of creating something different from the way the current work is can be perplexing and may cause discouraging feelings to staff. Thus, in decreasing or avoiding failure, the stakeholder or managers must learn how to recognise possible obstacles and also make use of effective approaches to remove these threats (Caldwell et al., 2008). Moreover, the SI to be used or already in use should develop a change theory that would offer the structure and monitor the change (Flamholtz and Randle, 2008).
CHANGE MODEL OR THEORY
Change theories or models have been developed from different disciplines and they have been implemented for planning and clarifying the procedures for change in healthcare settings. Kurt Lewin\’s theory of change developed in 1951 will be used to implement the proposed SI. The Lewin (1951) theory is used because it has the ability to bring about positive change which can result in an essential modification in the way hearing care for hearing impaired patients are given (Sullivan and Gayle, 2013). In addition, the structure for executing the HAP will be directed by Lewin’s model to bring awareness to the health professionals on how important hearing care is, for elderly patients with hearing impairment.
Lewin’s model (1951) relates to changes in human behaviour and the resistance to change. The model incorporates three different phases of change which are unfreezing, moving and freezing or refreezing (Bozak, 2003). Lewin’s model identifies forces that support or resist the change process. These forces are known as driving forces and restraining forces. Kaminski (2011) asserted that the driving forces introduce change and assist organisations in reaching their desired goals. While the restraining forces are static forces that hinders change (Payne, 2013).
Lewin’s change model is mainly used in the healthcare setting or organisation for effective change process (Payne, 2013). However, the planned approach change was criticised as being built on field theory (Burnes and Cooke, 2013), believing that the psychological forces affect the behavioural change of an individual.
UNFREEZING
According to Kaminski (2011), the most important components to unfreezing are identification of restraining, driving forces and communication. Whereas Sutherland (2013) identified that it is significant at this stage to compulsorily engage the stakeholders to work towards emphasising the positive driving forces and reduce the restraining forces if HAP were to be successful. Sullivan and Gayle (2013) recognised that the new behaviour which can be absorbed when the equilibrium between the restraining and driving forces are destabilised (unfrozen) before rejecting or discarding (unlearnt) the old behaviour or way.
The first stage is to notify the stakeholders of the need for effective change. This change is known as a felt-need (Burnes, 2004; Cummings and Worley, 2008 and Burnes and By, 2012). Felt-need was described as the recognition that change is required in the organisation to correct any insufficiencies. However, if the felt-need is not generated in the organisation, then there would be problems in bringing in change (Burnes, 2004). It might be sometimes difficult to involve the stakeholders, as Weiss (2014) identified that they might not be patient enough to pilot the SI. However, Morris, Malhotra and Lawrence (2013) suggested that the stakeholders are needed to improve the hearing care for the elderly or acute patients, because a team working without coordination would not achieve the required change.
A felt-need for HAP will be promoted among the stakeholders in the hospital by the use of presentation and communication of evidence gotten from patients’ care and as well as records and report of the Action on Hearing Loss (2013). This awareness is needed as it will give a structure, urgency and to motivate communication of several ideas (Sutherland, 2013) that will allow the stakeholders to generate a list of driving and static forces (Simon et al., 2016) which might influence the performance of HAP.
Moreover, the involvement of the stakeholders in developing the main decision-making structure will encourage a sense of empowerment that may aid to defeat resistance or struggle to change. It will also enable the stakeholders to understand the significance of HAP and how it will be helpful to the patients’ hearing care (Cummings and Worley, 2008). Furham (2012) argued that a more tailored and personalised approach is better and thus, opposed the notion of group behaviour. However, Lee-Ross and Lashley (2012) believed that individuals in or outside a group may respond to change, based on past experiences, present circumstances and future consequences. The negative experiences will bring doubt to the SI idea.
Perception and psychology are the other restrainings or static forces that are likely to generate obstacles during the unfreezing stage. Allen (2016) stated that at this stage, stakeholders may decide to either accept or reject the change project due to the way the HAP is understood. For HAP to overcome negative awareness, the stakeholders will be educated on how to use HAP by showing a virtual video that explains the benefits of the SI idea. According to Lee et al. (2009), training individuals about the motives for change can increase the strength of driving forces and assist in transiting such individual to be an advocate and not a skeptic.
Change, whether at the individual or group level is a profound psychological dynamic process that identifies the creation of psychological safety as one of the keys that unfreeze (Payne, 2013). During this period, the stakeholders might experience feelings of discomfort, dread and distress. In order to manage their psychology, the stakeholders must be made to feel safe from loss and humiliation before they can accept the new information and reject old ways (Burnes, 2004). This will enable the stakeholders to be comfortable with the new information for progress.
During the unfreezing stage, a higher number of stakeholders are needed to support the implementation of HAP. If this is not happening, the change may not be successful (Erwin and Garman, 2010). Therefore, to prevent the failure of HAP, issues of concern will be discussed with the stakeholders. The main aim of this stage is to persuade as many stakeholders as possible to accept HAP. Pare et al. (2011) opined that individuals may pretend and go with the rest of the group for fear of being rejected by their social group. Hence, it is essential to eliminate or reduce this type of behaviour. To achieve the elimination, an Audiologist will be invited to train and advise the stakeholders. This will support the effective and efficient delivery of hearing care to patients with hearing impairment while individual’s fear is addressed. Once the need for change has been perceived by the stakeholders and status-quo disrupted, the change agents can proceed to the next stage of the model (Hall and Hord, 2011).
MOVING
This is the second stage of Lewin’s model (1951) called the moving stage and it represents the period of implementing the actual change. Though, a cycle with four elements; plan, do, study and act (PDSA) tool were elaborated by the NHS Institute for Innovation and Improvement (2012) for the NHS. From this cycle, three activities will be embarked upon; nomination of a project sponsor or coordinator, further development of plans that strengthen the driving forces and elimination of the restraining forces and piloting (Hewitt-Taylor, 2013).
Initially, a senior member of staff will be nominated to lead the project for HAP to be successful (Will, 2016). Though, it is recognised that nominating a senior member may cause conflicts and opposition within the group, and in actual fact, Lewin’s model (1951) has been criticised for ignoring the role of power, politics and conflicting nature of much of organisational life. However, Gage (2013) suggested that it is significant to have a leader for the project that will organise, supervise and examine the effectiveness of HAP so that any new challenge discovered is resolved quickly.
Secondly, Franklin (2014) suggested that active participation of all stakeholders will create a sense of ownership for the success of the project like HAP. Therefore, to impel a sense of ownership, the stakeholders will be occupied to further identify the driving forces needed to improve the HAP. Staff will be encouraged to use the HAP as a test run to meet their patient’s hearing care. They will also be asked for their view and suggestions that would enhance the SI idea. Burnes (2004) recommended that it would be possible to understand why individuals, groups and organisations act as they do if one could identify and establish the strength of driving and static forces. Thus, what forces would need to be eliminated or strengthened in order to bring about change.
Lastly, a pilot design in the chosen surgical ward will be conducted. Piloting is an initial limited operation that is used to prove the feasibility of a project idea (Hewitt-Taylor, 2013). This stage is different from the unfreezing stage where all the stakeholders participated, a small number of patients with hearing impairment are needed to pilot the SI. During this stage, the Clinical Support Workers (CSWs) and Nurses will be encouraged to use the HAP as a disability sign for the patients with hearing impairment. This is necessary as the nurses and CSWs are used to giving care to patients with hearing impairment. They will be expected to incorporate the skills acquired during the training to enhance hearing care for their patients. Apart from enabling the stakeholders to manage the risk (Pare et al., 2011), piloting will confirm the appropriateness and safety of HAP; working practices are safe and comply with statutory standards to promote dignity in care (SCIE, 2013). If they got actively involved and personally committed to using the HAP for the patients, the stakeholders are more likely to key into the change project (Allen, 2016).
REFREEZING
Refreezing seeks to stabilise the group at a new quasi-stationary equilibrium in order to ensure that the new behaviours are relatively safe from regression (Lewin’s model, 1951). While Paton and McCalman (2008) supported Lewin model on the importance of the stability in the group. Adding that group norms should be transformed for sustainable changes in individual behaviour. Contrarily, Murthy (2007) argued that groups are never frozen, rather they are like fluid entities with many personalities.
Payne (2013) emphasised that making the stakeholders, especially the nurses and CSWs to implement HAP, will disrupt the workflow which may stir up negative feelings. Hence, the refreezing stage will be the time for alleviating and re-assessing HAP. This will be achieved by providing the stakeholders with ongoing support in the form of training and ensuring the products are available for use on the ward. Furthermore, monitoring and recording compliance, liaising and seeking expert advice as well as periodic supervision of HAP.
Progressive evaluation is necessary to decide if the HAP is supporting other stakeholders if they are fulfilling their professional responsibilities, the patients with hearing impairment to meet their hearing needs and organisational standards are adhered to (Hewitt-Taylor, 2013). It is hoped that a norm culture is enhanced and full adoption is achieved as a positive impact of the use of HAP begins and expand (Sutherland, 2013).
LEADERSHIP STYLE
Leadership is described as the motivation of leading a group of people to get the work done (Sliva, 2016). Gage (2013) suggested that good nurse leadership is the key to a successful SI. To bring about a successful HAP outcome, the leadership requires problem-solving skills, decision-making, interpersonal and communication skills (Will, 2015). According to Mosadegh and Yarmohammadian (2006), there are few types of leadership style, such as autocratic, laissez-faire, charismatic, democratic, participative, bureaucratic, situational, transactional and transformational.
The most popular leadership styles in healthcare organisations are the autocratic, transformational, laissez-faire and democratic leadership styles (Warrilow, 2012). For, The democratic leadership style will be used for the HAP development. The reasons for this choice is that this leadership style aligns with the implementation of Lewin’s (1951) theory of change which suggests that every member of the group must work together in order to achieve the desired outcome.
Marriner-Tomey (2009) argued in support of democratic leadership style in healthcare and emphasised that a total involvement of members of a team can increase motivation and creativity when people that have the knowledge and skills, work together over a period of time. However, democratic style can be difficult and time consuming to gather input and that some team members might overpower others by being aggressive leaving nervous team members with no chance to put their ideas forward (Lorraine, 2010).
Though, Sliva (2016) suggested that both aggressive and nervous team members could be handled through supervision and support. However, Lee (2006) maintained that democratic leadership style does not exist in the real world of healthcare in that, employees usually do not have much say in policy implementation. As staff is required to use new products or technology, whether they want to or not. This does not entirely happen in the UK.
Furthermore, the leader will specifically give attention to emotional competence, cognitive competencies and social or emotional intelligence (Boyatzis, 2009), so as to avoid “tick box” development and bring about a successful operation of HAP. This is significant, given the emotional dimension in leading change and the fact that it is not simply what we do, but how we do it (Alimo-Metcalfe and Bradley, 2009). Moreover, Dulewicz and Higgs (2003 cited in Willcocks,2012) have demonstrated that emotional intelligence is a critical factor in effective leadership by translating emotional competencies such as listening and sensitivity, motivation and energy, influence and adaptability, integrity and decisive into quality service delivery for people and task-centred approach.
Mosadegh and Yarmohammadian (2006) affirmed that whichever leadership styles a project leader prefers, the most important thing, is the ability of the leader to influence subordinates to perform at their highest capability. However, Fitzgerald et al., (2013) stated that there is no agreement among healthcare professionals as to which particular leadership style will result in the most effective for an organisational behaviour.